Common Myths about Dental “Insurance”

Insurance Companies/Benefits2019-10-08T21:12:56-04:00

MYTH: It works just like medical insurance

FACT: What is commonly referred to as dental “insurance” is actually reimbursement. Available plans do not insure your teeth or gums, as you would insure your life, health, auto or house. These plans have more extensive limitations than other types of insurance.

MYTH: I can have as much dental work done as needed without a limit

FACT: Most dental plans have a maximum pay out per patient of $1000-$1500 annually. Most plans pay only a percentage of the fee charged or the fee allowed. Dental reimbursement best serves those individuals who practice preventative oral health care and need some occasional dental treatment. It is not a panacea for those who may have been neglectful and need extensive dental treatment.

MYTH: I need dental insurance in order to go to the dentist.

FACT: Most dentists will provide quality care to patients regardless of their financial situation and regardless of whether or not they have dental “insurance”. Most offices offer a variety of payment options and financing arrangements.

MYTH: My dentist knows what plan I have and what my coverage is.

FACT: While dental offices do have access to services that provide information about dental plans, because of the vast variety of plans and the constant changes being applied to plans, it is ultimately the responsibility of the patient to know what they have and then use the dental office team members to explain and utilize the plan.

MYTH: I can no longer go to my favorite dentist because they are not in my network.

FACT: You can go to any dentist you wish as long as you are aware of the following:

  • If you have a DMO or closed panel type plan you can only receive a benefit if you go to an IN network dentist, but can still go anywhere.
  • If you have a PPO, which is what is most commonly available, you can go to an IN network or OUT of network dentist, with the understanding that there is usually a reduced out of pocket expense if you stay In network.
  • Indemnity plans offer the best benefit regardless of In network or Out of network.

MYTH: My employer does not provide a dental benefit, or I’m retired and no longer have plan; therefore I must buy a plan.

FACT: Always talk to your dentist prior to purchasing any dental plan. For the average individual who has maintained good oral health, the cost of purchasing a dental plan for 5 years, far exceeds the cost of paying the dentists fee for preventative and basic procedures.

MYTH: If I want a dental plan the insurance carriers are the best resource.

FACT: While insurance carriers offer dental plans, your best resource for information is your dentist, or the New Jersey Dental Association.

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